Anterior Shoulder Instability

Anterior Shoulder Instability

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What is Anterior Shoulder Instability?

Anterior shoulder instability refers to a condition where the humeral head dislocates or subluxes from the glenoid fossa due to damage or weakness in the surrounding structures. This condition is prevalent among athletes and individuals who engage in overhead activities, making early diagnosis and effective management crucial to prevent recurrent dislocations and maintain shoulder function.

Anterior Shoulder Instability Statistics

  • Anterior shoulder dislocations account for 95% of all shoulder dislocations.
  • Younger patients, particularly those under 20 years, have up to a 90% chance of recurrence after an initial dislocation.
  • Source: Medscape
  • Anterior Shoulder Instability Anatomy

  • The glenohumeral joint is a multi-axial spheroidal joint formed by the humeral head and the glenoid fossa of the scapula.
  • Stability is provided by both static structures (glenoid labrum, joint capsule, glenohumeral ligaments) and dynamic structures (rotator cuff muscles, deltoid, biceps brachii).
  • The labrum deepens the glenoid cavity, enhancing the joint's stability.
  • Anterior Shoulder Instability
    Signs & Symptoms

  • Severe pain and inability to move the shoulder after dislocation.
  • Recurrent shoulder instability with activities that involve abduction and external rotation.
  • Weakness in external rotation and "dead arm" sensation during overhead sports activities.
  • Apprehension or fear when the shoulder is placed in certain positions, especially overhead.
  • Causes of Anterior Shoulder Instability

  • Trauma: A sudden force or impact to the shoulder can cause dislocation.
  • Repetitive overhead activities: Sports like volleyball, swimming, and tennis can lead to gradual weakening of shoulder stabilizers.
  • Congenital laxity: Some individuals are born with more flexible joints, making them prone to instability.
  • Risk Factors for Anterior Shoulder Instability

  • Age: Younger individuals, especially athletes, are at higher risk of recurrence after an initial dislocation.
  • Sports involvement: Athletes in contact or overhead sports have a higher incidence of shoulder instability.
  • Previous dislocations: A history of shoulder dislocations increases the risk of future episodes.
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    Prevalence of Anterior Shoulder Instability

  • Anterior shoulder dislocations are more common than posterior dislocations, representing up to 95% of cases.
  • Recurrent dislocations are more likely in younger populations and those with high physical demands.
  • Assessment & Diagnosis of Anterior Shoulder Instability

  • History and physical examination are crucial, focusing on previous dislocations, trauma history, and shoulder stability.
  • Apprehension, Relocation, and Surprise tests are specific physical tests used to diagnose anterior shoulder instability.
  • Imaging: X-rays, MRI, and CT scans are utilized to assess the extent of damage to the labrum, ligaments, and bony structures.
  • Rehabilitation & Physiotherapy for Anterior Shoulder Instability

  • Phase I: Acute motion phase - Focus on pain management, reducing inflammation, and restoring range of motion with exercises like pendulums and isometrics.
  • Phase II: Intermediate phase - Emphasize strengthening, particularly of the external rotators and scapular stabilizers, while continuing ROM exercises.
  • Phase III: Advanced strengthening phase - Progress to functional and sport-specific exercises, incorporating plyometric training and neuromuscular control drills.
  • Phase IV: Return to activity phase - Focus on maintaining strength and stability while gradually returning to full activities or sports.
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    Anterior Shoulder Instability FAQs

    The most common cause of anterior shoulder instability is a traumatic event, such as a fall or impact, that forces the shoulder into an extreme position, causing dislocation.

    Diagnosis typically involves a combination of patient history, physical examination, and imaging tests like MRI or CT scans to assess damage to the shoulder structures.

    Yes, many cases of anterior shoulder instability can be managed with physiotherapy focusing on strengthening, stability exercises, and activity modification to prevent recurrence.